High-grade pivot-shift phenomenon after anterior cruciate ligament injury is associated with asymmetry of lateral and medial compartment anterior tibial translation and lateral meniscus posterior horn tears

Ni, Qiankun; Guo, Qi; Li, Ming; Liu, Ning; Zhang, Hui

doi:10.1007/s00167-022-06972-x

Cited by 9 publications

(12 citation statements)

References 39 publications

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“…In accordance with Magnussen et al 27 and Bernholt et al, 11 our study found that high-grade pivot shift or rotatory instability was confined to grade 3 pivot shift, whereas the same term was defined as a PST grade 2 or 3 by other researchers. 25,37,45 Moreover, our MRI protocol of knee positioning was similar to the protocols described by Tanaka et al 49 and McDonald et al 34 (mild extension with slight external rotation) and was different from the protocols that entailed full extension or hyperextension applied by Lian et al 24 and Liu et al 25 Previous studies have verified the secondary stabilizing effects of MM, LM, and ALL. The MM and LM act as secondary restraints of the tibia to anteriorly directed forces and pivoting maneuvers, respectively, 13,36,38 whereas the posterior horns of menisci may be more crucial.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies have reported an association between static tibial subluxation on MRI and knee rotatory instability in dynamic tests. 24,25,37 Notably, a biomechanical study revealed that 6 mm of anterior tibial translation in the lateral compartment was necessary to produce a positive pivot shift, 10 which subsequently was applied as a threshold of “resting pivoted position” in several studies. 25,34,45 However, the tibial translation in dynamic testing may not be equivalent to the static subluxation.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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Background: High-grade knee laxity and excessive anterior tibial subluxation (ATS) are correlated with poor clinical outcomes in patients with anterior cruciate ligament (ACL) deficiency and share similar risk factors; however, the association between excessive ATS and high-grade knee laxity remains unclear. Purpose: To identify the association between excessive ATS and high-grade knee laxity in patients with ACL deficiency and determine the possibility that ATS can predict high-grade knee laxity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 226 patients who underwent ACL reconstruction between May 2018 and March 2022 were analyzed in the present study; the high-grade group consisted of 113 patients who had a grade 3 result on the preoperative anterior drawer test, Lachman test, or pivot-shift test while under anesthesia, and the low-grade group consisted of 113 matched patients. The ATS values for medial and lateral compartments (ATSMC and ATSLC) were measured on magnetic resonance imaging while patients relaxed the quadriceps in the supine position under no anesthesia. The optimal cutoff values of ATSMC and ATSLC for high-grade knee laxity were determined using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses with stratification were performed to identify the association between excessive ATS and high-grade knee laxity. Results: Compared with the low-grade group, the high-grade group had a longer time from injury to surgery; higher rates of medial meniscus posterior horn tear (MMPHT), lateral meniscus posterior horn tear (LMPHT), and anterolateral ligament (ALL) abnormality; and larger lateral tibial slope, ATSMC, and ATSLC. The optimal cutoff value was 2.6 mm (sensitivity, 52.2%; specificity, 76.1%) for ATSMC and 4.5 mm (sensitivity, 67.3%; specificity, 64.6%) for ATSLC in predicting high-grade knee laxity. After adjustment for covariates, ATSLC ≥4.5 mm (odds ratio [OR], 2.94; 95% CI, 1.56-5.55; P = .001), MMPHT (OR, 2.62; 95% CI, 1.35-5.08; P = .004), LMPHT (OR, 2.39; 95% CI, 1.20-4.78; P = .014), and ALL abnormality (OR, 2.09; 95% CI, 1.13-3.89; P = .019) were associated with high-grade knee laxity. The association between excessive ATSLC and high-grade knee laxity was validated in patients with acute ACL injury as well as those with chronic ACL injury. Conclusion: Excessive ATSLC was associated with high-grade knee laxity in patients who had ACL deficiency, with a predictive cutoff value of 4.5 mm. This study may help surgeons estimate the degree of knee instability more accurately before anesthesia and may facilitate preliminary surgical decision-making, such as appropriate graft choices and consideration of extra-articular augmentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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“…Accordingly, numerous studies have started to pay attention to the regions of meniscal injury. 7,41,50 Previous studies have recognized that the unique biomechanical properties of the meniscus are determined by its complex extracellular matrix (ECM), which is composed largely of collagen and glycosaminoglycan (GAG). 31,35,38 Collagen provides tensile strength for the meniscus, whereas GAG maintains the compressive properties of the meniscus.…”

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confidence: 99%

“…34,50 Acute ACL rupture with a high-grade pivot-shift phenomenon is commonly associated with a posterior horn tear of the lateral meniscus (LM). 18,41 In cases of chronic ACL deficiency, an injury to the medial meniscus (MM) is very common and frequently located at the posterior horn. 46,50 However, the mechanisms of meniscal injury in specific regions after ACL injury are unclear.…”

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Regional Alterations of Macroscopy and Histology in Meniscus in an ACL Transection Rabbit Model

et al. 2023

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Background: Although meniscal injury is common after anterior cruciate ligament (ACL) injury, the underlying process in different meniscal regions remains unclear. Purpose: To investigate macroscopic and histological alterations in different meniscal regions in an ACL transection (ACLT) rabbit model. Study Design: Controlled laboratory study. Methods: ACLT was performed on New Zealand White rabbits. Both the medial meniscus (MM) and the lateral meniscus (LM) of the ACLT knees were obtained at 8 (n = 6) and 26 (n = 6) weeks postoperatively. MM and LM collected from nonoperated knees were considered 0 weeks (n = 6) postoperatively. Menisci were then divided into posterior, central, and anterior regions for macroscopic (width) and histological (hematoxylin and eosin, safranin O/fast green, collagen type 2 [COL2]) analysis. Results: The macroscopic widths of MM and LM increased and then decreased over 26 weeks postoperatively, with all 3 MM widths at 8 weeks significantly wider than at 0 weeks (posterior: P < .01; central: P < .05; anterior: P < .05). In the MM, chondrocyte-like cell density increased and then decreased postoperatively, whereas in the LM, it decreased and then remained almost unchanged. Cell density was significantly higher in the central MM region at 8 weeks than at 0 weeks ( P < .05). Glycosaminoglycan (GAG) and COL2 percentages of MM and LM decreased from 0 to 8 weeks and then returned to nearly normal levels at 26 weeks postoperatively. In the MM, the GAG percentage in the posterior ( P < .05) and central ( P < .01) regions and the COL2 percentage in the posterior region ( P < .05) was significantly lower at 8 weeks than at 0 weeks. Conclusion: After ACLT in rabbit meniscus, the extracellular matrix (ECM) initially decreased and then increased to almost normal. Additionally, there were significant differences in the ECM percentage in the posterior and central regions of the MM in comparison with other meniscal regions between 0 and 8 weeks postoperatively. Clinical Relevance: The results indicate that the time for meniscal injury after ACL injury is important, and attention should be paid to the posterior and central regions of the MM after ACLT.

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Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

Bai,

Zhang,

Hong

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL−M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure.MethodsPubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random‐effects model was employed to calculate the overall standardized mean difference between the two groups.ResultsA total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL−M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL−M (p = 0.039) compared to the control group.ConclusionIncreased ATS and ATSL−M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR.Level of EvidenceLevel III.

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High-grade pivot-shift phenomenon after anterior cruciate ligament injury is associated with asymmetry of lateral and medial compartment anterior tibial translation and lateral meniscus posterior horn tears

Cited by 9 publications

References 39 publications

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Regional Alterations of Macroscopy and Histology in Meniscus in an ACL Transection Rabbit Model

Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

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